Guttmacher Institute Slams Misuse of Own Study on Abortion and Insurance Coverage

Last night Rahm Emanuel held a “frank discussion” with a collection of pro-choice groups in the White House about the Stupak amendment. He’ll be meeting with “faith groups” next, according to the readout.

One wonders if Rahm was making the same argument to those pro-choice groups that liberal elite opinionator E.J. Dionne makes in the Washington Post today.

The Michigan Democrat’s measure — passed 240 to 194, with 64 Democrats voting yes — would prohibit abortion coverage in the public option and bar any federal subsidies for plans that included abortion purchased on the new insurance exchanges […]

Whatever else is true, Stupak’s amendment is unlikely to have a significant effect on the availability of abortion. And most abortions are not paid for through health insurance. The Guttmacher Institute, for example, reported that only 13 percent of abortions in 2001 were directly billed by providers to insurance companies — although the institute has cautioned that the proportion of women whose abortions were covered by insurance could be higher because the figure did not include those “who obtain reimbursement from their insurance company themselves.”

This is untrue in several respects. First, as Jon Walker has tirelessly pointed out, the amendment as written could easily apply to multiple funds given to employer-based plans in the health care bill. Second, saying that the restrictions will be “confined to the exchanges,” even if true, neglects the fact that the exchanges under the bill are set to expand, perhaps encompassing the entire insurance market.

And third, the widely-used Guttmacher Institute study, claiming that only 13% of abortions in 2001 were directly billed to insurance companies, has been misappropriated to minimize the consequences of the Stupak amendment. You don’t have to believe me – believe the Guttmacher Institute, who posted this response on their website.

However, that statistic alone misrepresents the situation on three counts:

Our study included all women who obtained abortions in 2001, including women on Medicaid and those who are uninsured. If one looked only at privately insured women, the percentage of procedures billed directly to insurance companies would be substantially higher than 13%.

Perhaps even more importantly, the 13% statistic does not include women who pay for an abortion up front and then seek reimbursement from their insurance provider. This is common when a medical provider does not participate in a patient’s insurance plan, as is often the case with small, specialized providers, including abortion providers.

Lastly, some of the women whom our study identified as paying out of pocket likely had insurance coverage for abortion care, but may not have known they had it or chose not to use it for reasons of confidentiality. Given the stigma that still surrounds abortion, many women might not have wanted their insurer or employer—or their spouse or parent who may be the primary policyholder—to learn that they had obtained an abortion. That antiabortion activists who have worked for decades to perpetuate that stigma are now turning around and using it to argue why women should not be able to purchase insurance coverage for abortion is deeply cynical.

Guttmacher says that available evidence shows most people in employer-based coverage, in other words a majority of the country, have abortion services covered in their health plans. Restricting that coverage, and eventually carrying that restriction into the entire market, would represent a tremendous change, not the small, meaningless alteration that Dionne – and I suspect, Rahm Emanuel – is arguing.